This being the month to celebrate mothers, it seems timely and important to ask, why is maternal morality so high in this country?

According to a recent report by the Commonwealth Fund, American women have the highest risk of dying from pregnancy complications than in any other high-income country. Their report shows that we have 14 deaths per 100,000 births; the Centers for Disease Control puts it even higher at 18 per 100,000 births. Compare that to Sweden’s 4 per 100,000 or the UK rate of 9 per 100,000 and we are not so “developed” as we think.

Maternal mortality is “a death that occurs during pregnancy or within a year postpartum from a pregnancy complication, a chain of events initiated by pregnancy, or the aggravation of an unrelated condition by the physiological effects of pregnancy.” In the U.S. it has risen to the level of social crisis from a public health perspective. Our maternal mortality rates have more than doubled in the last twenty years, with African American women suffering at the alarming rate of 40 deaths per 100,000. Some experts say it’s getting deadly to give birth here.

Several factors are at play, but one big problem relates to our high C-section rate. A third of American mothers are now delivering by Cesarean section, an increase of more than 500 percent since the 1970s. That’s an astounding figure even if surgery can be necessary sometimes. But what doctors, and moms who elect to have a section, often forget is that we’re talking about major surgery, not something as simple as a tooth extraction.

As the World Health Organization notes, C-sections are effective in saving maternal and infant lives, “but only when they are required for medically indicated reasons.” C-section rates higher than 10 percent, the organization says, are not associated with reductions in maternal and newborn deaths.

“We’ve designed the birth environment to resemble an Intensive Care Unit. Ninety-nine percent of American women deliver in environments that resemble ICUs, surrounded by surgeons,” Dr. Neel Shah, a professor at Harvard Medical School, told a New York Times reporter.

Midwives, who’ve been delivering babies for millennia, have known for a long time that woman-centered childbirth is basically a natural process that, with appropriate support, ends well; it is not routinely a medical emergency. Women who elect to have midwife-assisted deliveries, a practice that has grown since the 1970s thanks to women’s health advocates, know this too.

The midwifery model espouses a holistic approach to childbirth that includes affirmation and comfort as a woman experiences one of the most significant lifetime events. Midwives are highly trained professionals who call in a physician if the situation warrants, and research shows they have better outcomes than physician-directed births. In addition to skills and techniques that can avert an intervention, midwives have an abundance of patience. They understand that birth cannot be rushed, and they know that less medicalization is appropriate in normal births rather than more.

In most countries, mothers deliver their babies with midwives, who provide a relaxed but watchful environment. In this country, as research by Dr. Shah noted, a surgical delivery has less to do with health issues or particular physicians than with the hospital in which a mom delivers. “Your biggest risk factor is which door you walk into,” he says. That’s particularly true in urban cities and teaching hospitals. It’s also why women are now alert to “buyer beware birthing environments.”

Birthing centers like the one at South Shore Hospital in Weymouth, Massachusetts are breaking new ground in woman-centered childbirth. A team of experts there committed to reducing the C-section rate have developed a model to reduce Cesarean sections in collaboration with Dr. Shah and others at physician-writer Atul Gawande’s Boston Ariadne Labs. Recently they made national news when the team delivered twins naturally, one of whom (at least) would have been deemed a section in most other delivery suites.

In 2017 the House of Representatives introduced the Preventing Maternal Deaths Act which directs the Department of Health and Human Services to offer a range of ways to reduce the maternal mortality rate, including Maternal Mortality Review Committees, at the state level. It also provides for public disclosure of information in state reports. Passed by the Senate, Donald Trump signed the bill into law in December 2018.

In the U.S., the C-section rate continues to vary from seven to 70 percent, while the CDC estimates that 60 percent of maternal deaths in the U.S. are preventable. Those are shocking numbers, especially in a so-called developed country that reveres motherhood, at least rhetorically.

The lives of childbearing women in this country depend on the success – and implementation – of established and proposed legislation, especially to address structural inequities that put black, indigenous and rural families at disproportionate risk, making policy changes relating to Medicaid imperative. Several Democratic legislators have introduced such legislation.

For it to make its way through the labyrinth of public policy, people who care about moms, wives, and other American women, urgently need to advocate on their behalf.